Advantages of 3D Printing in Healthcare

ONE INSTITUTE ’S COLLABORATIVE
PROCESS IMPACTS MEDICINE

The Jacobs Institute (JI), a
non-profit medical innovation ‏centre in Buffalo, New York, is using 3D
printing to ‏further its mission of creating the next generation of ‏medical
technology to treat vascular disease, such as heart ‏attack and stroke. One of
the ways it achieves this is by partnering ‏with researchers at State
University of New York at ‏Buffalo (UB) and surgeons at the Gates Vascular
Institute ‏(GVI) to plan for complex vascular surgeries.

A few years back, UB biomedical
engineers, in consultation ‏with neurosurgeon and JI chief medical officer
Adnan ‏Siddiqui, PhD, MD, FACS, FAHA , developed a way to 3D-print ‏brain
arteries to better understand brain aneurysms and ‏stroke. As technology and the
team’s creativity evolved, so ‏did the realism, complexity, and specificity of
the 3D-printed ‏models. It began in a university lab as an experiment, where ‏the
biomedical engineers painted layers of silicone over a ‏Play-Doh model of a
brain aneurysm. Once the Play-Doh ‏was dissolved away inside the silicone, it
created a single, ‏hollowed-out blood vessel. This was a tedious process. It ‏was
improved rapidly by a technology called additive manufacturing, ‏also known as
3D printing. The UB lab purchased ‏a Stratasys Eden 260V 3D printer, which took
brain artery ‏modeling to the next level.

Making Progress

In the last two years, UB and JI
engineers collaborated to ‏create 3D-printed models of arteries to be used in
various ‏ways, including physician training, device testing, and surgical ‏planning.
These arterial models, known as “vascular phantoms”, ‏can be used for:

Entrepreneurs to bring their
endovascular device prototypes ‏and deploy them inside the models, to see how ‏the
device performs in a life-like environment;

Gates Vascular Institute surgeons
requesting a 3D replica ‏of a specific patient’s anatomy to practice surgery— ‏whether
to make an appropriate device selection or to ‏practice the surgical approach
in a particularly complex ‏anatomy—before touching the patient in an actual
catheterisation ‏lab. These models are only created for select ‏patients with
complex anatomies, not every patient. ‏

Showcasing the collaborative
accomplishments with the ‏university, the hospital, and building a relationship
with Stratasys ‏allowed the JI to advance 3D printing further. It was
designated ‏as a Stratasys “3D Printing Center of Excellence in ‏Healthcare” in
April 2016. The JI acquired a new 3D printer ‏because of the Stratasys
partnership and a grant from the ‏James H. Cummings Foundation.

In order to create the
patient-specific vascular phantom, there ‏are steps that the team of biomedical
engineers must follow. ‏It is a process largely reliant on various computer
programmes ‏to render a final file that can be loaded into the 3D printer.

Biomedical engineers take a
patient’s MRI or CT scan and, ‏using specialised computer software (Toshiba
Vital Images), ‏they identify the patient’s individual brain arteries in a
process ‏called “segmentation”. Next, another computer programme ‏(Autodesk
Meshmixer) is used to hollow-out the vessels and ‏add support and connectors,
which attach the printed model ‏to a cardiac pump to simulate blood flow.
Afterward, the ‏fully-refined and translated computer model is loaded into a ‏program
called Objet Studio, which is what the Stratasys Objet ‏500 Connex 3
multi-material printer reads to create the 3D model. Once printed, the
biomedical engineers then clean and ‏physically hollow out the model using a
clean station, which ‏removes support material and transforms it into a useable
‏model. The model then accurately replicates the structure, ‏texture, and
fragility of human vasculature. The physicians ‏have a model of human
vasculature on which they can train ‏other surgeons, test endovascular device
prototypes, or even ‏plan and practice for a complex surgery.

Surgical Application

In the case of surgical planning,
the surgeon assembles the ‏surgical team in the Jacobs Institute Training
Centre to perform ‏the procedure on the model under fluoroscopy. The surgeon’s ‏team
is joined by JI engineers, who can converse about the ‏model’s properties or
structure. The JI also documents the ‏procedure, capturing surgeon feedback on
the models and ‏the surgical approach. The JI take photographs and videos, ‏to
further catalogue the experience. The surgeon and the ‏surgical team use the
models to crystallise the plan in several ‏ways during a practice surgery.

First, the surgeon must determine
the optimal path to deploy ‏the device. Using the model can help the surgeon
recognise ‏if using a certain vessel pathway is helpful or problematic. It ‏can
also assist the surgeon in recognising which vessels are ‏twisted, or tortuous,
and exactly how to handle the catheters ‏and wires to navigate the bends and
turns.

Then, once the surgeon reaches the
affected area of the ‏blood vessel, they can try using a particular device to
treat ‏it—whether it is a device that will retrieve a clot in the case ‏of a
stroke, or a stent and coil duo to treat an aneurysm. After ‏deploying the
device, a surgeon may find deployment is too ‏difficult or that a different
device might be better suited for ‏treatment of that particular case. Finally,
the surgeon would ‏use the original or try an alternate device during the
actual ‏surgery, with greater confidence that the original device would ‏have
been unsuccessful.

There are numerous advantages to
patients, surgeons, and ‏hospitals in using a 3D-printed model to devise an
optimal ‏surgical plan. It: ‏

Allows surgeons to try a particular
approach or device in a risk-free environment;

Provides the surgeon with practice
time before performing the actual surgery, much like medical simulation;

Minimises the time a patient is on
the table, being exposed to harmful radiation, as a surgeon tries to figure out
the best approach;

Michael is the director of
operations and entrepreneurship for the Jacobs Institute, focusing on
innovation, business development, and operations. Michael is a biomedical
engineer with extensive strategic planning and operations management experience
in the medical device space, having worked with several companies in the
sector. He oversees the JI’s team of biomedical engineers, as they implement
and improve 3D printing in healthcare. Michael interfaces with the medical device
industry, the hospital, and the university to achieve the JI mission. He is
currently preparing to launch the JI’s Idea to Reality Center, or i2R, which
will be a proof of concept center for neuroendovascular devices.

Richard L. Izzo Graduate Research

Assistant, State University of New
York at Buffalo Rick graduated from the University at Buffalo (UB) in May 2015 with
a double degree, B.S. in biomedical engineering and B.A. in chemistry. Rick is
currently pursuing his PhD in biomedical engineering, specialising in 3D
printing in healthcare, under the advisement of Ciprian Ionita, PhD. In this
capacity, he works collaboratively with the JI. Previously, he was a JI intern.
While in undergraduate school, he worked as a researcher in UB’s Lovell
Nanomedicine Laboratory and under Renee Reynolds, MD, in his senior year to
understand paediatric neurological conditions. Rick served as first author on
one journal article. He has also given presentations at five conferences,
presented two webinars, and was a featured speaker at the Virtual 3D Printing
in Medicine Summit.

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